Transcript Fostering Healthy Futures Kempe Children’s Center

Fostering Healthy Futures
for Preadolescent Youth
in Foster Care
Heather Taussig, Ph.D.
Associate Professor of Pediatrics and Psychiatry
Kempe Center, University of Colorado
University of Maryland, Baltimore
School of Social Work
Lunch Time Research Seminar
November 11, 2010
“Our children’s future and the world’s future are one.”
~ Dr. C. Henry Kempe
Fostering Healthy Futures
Program Design
All children receive:
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Baseline and follow-up interviews
Baseline evaluations of their functioning
Those randomized to the 9-month prevention
program receive:
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Mentoring/Advocacy
Therapeutic Skills Groups
Presentation Overview
Fostering Healthy
Futures Program
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Program Development
Preventive Intervention
Teaching/Training
Research
Lessons Learned
Future Plans
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It Takes a Village
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Denver Department of Human Services
Adams County Social Services Department
Jefferson County Human Services
Arapahoe County Department of Human Services
Broomfield County Health and Human Services
Colorado Department of Human Services
Graduate schools - DU, Newman, CSU, UCD
School districts and schools
Mental health centers and therapists
Children and families
CASRC
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David Olds
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Prior staff
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Ann Petrila
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Daniel Hettleman
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Kempe Center
Kempe Foundation
Volunteers
Department of Pediatrics
Youth Mentoring Collaborative
Developmental Psychobiology Research Group
Fostering Healthy Futures Team
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Sara Culhane, Ph.D., JD
Melody Combs, Ph.D.
Orah Fireman, LCSW
Edward Garrido, Ph.D.
Rebecca Gennerman-Schroeder, MA, LPC
John Holmberg, Psy.D.
Jenny Koch, MSW
Mike Knudtson, MA
Christie Petrenko, Ph.D.
Heather Taussig, Ph.D.
Robyn Wertheimer, LCSW
FHF Graduate Student
Research Assistants and Group Leaders
• Brendan Close
• Erika Joye
• Nicole Lariviere
• Amy Franke
• Mia Kim
• Jessi Wheatley
• Melani Dawson-Lear
• Melanie Rodriguez
• Riley Spuhler
• Walter Heidenreich
• David Roberts
• Alexis Karris
• Marisa Duran
• Patrick Nickoletti
• Shawna Henry
• Dena Miller
• Thea Wessel
• Jennifer Sackett
• Amy Percosky
• Tisha Bean
• Emily Macdonald
• Jill Gjerde
Rachel Lund
Ann Chu
Yael Chatav
Tiffany Conway
Tracy Rudhe
Brian Wolff
Jenn Winkelmann
Pam Freeman
Danielle Smith
Amanda Brown
Heather Frey
Vyga Kaufmann
Neta Bargai
Julie Bemski
Jenell Ribble
Martine Lopez
Alana Henken
Kathryn Jargo
Liz Hooks
Tara Buckley
• Jordan Pock
• Andrea Reece
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Sara Rosenau
Natalie Tolejko
Kristen Simpson
Shari Watters
Kristen Mackiewicz
Michelle Brunner
Lindsay Heath
Kristin Nelson
Kate Slivka
Lindsay Smart
Susan Whittle
Elizabeth Goetter
Julie Lyons
Courtney Fiedler
Edyta Biegunajtys
Claire Heppner
Clara Paynter
Kelsey McNeill
• Thea Wessel
• Alana Henken
• Julie Bemski
• Claire Heppner
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•Amy Percosky
• Andrea Temple
• Allison Glover
• Sarah Morehouse
• Jennifer DeVault
• Debra Boeldt
• Christine Kelley
• Denise Onofrey
• Alanna Gangemi
• Jenny Doft
• Jenea Jones
• Kristin Allen
• Maddie Philley
• Rachel Shulman
• Leigh Clasby
• Sarah Perzow
• Erica Ragan
• Emily Rotbart
• Laurel Story
• Mayla Yang
FHF Graduate Student Interns
2002-2003
• Melani Dawson-Lear
• Kristine Wilson
• Brenna Ellington
• Lanette Ambers
• Carrie Oliver
2003-2004
• Amy Bruner
• Liz Dinsdale
• Vashawn Banks
• Josh Goldman
• Marisa Duran
• Amber Cross Thomas
• Melanie Rodriguez
• Clover Bone
2004-2005
• Tiffany Conway
• Katie Ferguson
• Katie Melstrom
• Lisa Meyers
• Kendra Sasa
• Carla Scarpone
• Lewis Smirl
• Kelsey Wennesland
• Regina Richards
2005-2006
• Michelle Brunner
• Jocelyn Gray
• Jon Phillips
• Jennifer Stucka
• Christina Haskins
• Tina Francis
• Sarah Kane
• Mark Spehn
• Jennifer Nelsen
2006-2007
• Lorendia Schmidt
• Phoung Phan
• Beth Lipschutz
• Jacquelyn Eisenberg
• Angela Bierle
• Lisa Harrison
• Nicole Henkins
• Erin Hoglund
2007-2008
• Kerrie Earley
• Ashley Moore
• Justine Stewart
• Lauren Goldberg
• Marissa Nasca
• Amber Wolfe
• Jennifer Reynolds
• Krystal Caduff
2007-2008 (cont.)
• Miranda Learmonth
• Molly Jenkins
• Rebekah Koenigbauer
• Sarah Oakley
• Lauren Timkovich
• Sam Murillo
• Elizabeth Berling
• Kristin Krietemeyer
2008-2009
• Rachel Alpert
• Katherine Belcher
• Taylor Collins
• Renata Heberton
• Alyse Keilson
• Blake Konner
• Emily Lyons
• Melissa Maurer
• Regan Linton
• Nina Modern
• Jennifer Pitcavage
• Meredith Schaffer
• Holly Selepouchin
• Heidi VanEpps
• Katherine Ware
2009-2010
• Lissa Miller
• Jenna Brown
• Jane Simon
• Allison Harris
2009-2010 (cont.)
• Shane Spears
• Jolie Rinebarger
• Diane Bouhall
• Kelly Fries
• Erica Brown
• Shavon Perkins
• Jess Valsechi
• Katie Kaser
• Britta Johnson
• Renea Nilsson
• Laura Merten
• Kyle Steinke
2010-2011
• Mele Cabral
• Jon Florida
• Sibyl Graham
• Beth Hilligoss
• Tighe Kaysar
• Alexandria Lewis
• Sarah Romero
• Stacy Walsh
• Jessica Devore
• Jacquelyn Gabel
• Jeffrey Hatcher
• Ryan Holmes
• Emily Laux
• Megan Lovingier
• Sapphire Rosier
• Cami Wangaard
*Over 50,000 hours of training provided to 88 interns
FHF Graduate Student
Research Assistants and Group Leaders
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Brendan Close
Erika Joye
Nicole Lariviere
Amy Franke
Mia Kim
Jessi Wheatley
Melani Dawson-Lear
Melanie Rodriguez
Riley Spuhler
Walter Heidenreich
David Roberts
Alexis Karris
Marisa Duran
Patrick Nickoletti
Shawna Henry-Lange
Dena Miller
Thea Wessel
Jennifer Sackett
Amy Percosky
Tisha Bean
Emily Macdonald
Jill Gjerde
Rachel Lund
Ann Chu
Yael Chatav
Tiffany Conway
Tracy Rudhe
Brian Wolff
Jenn Winkelmann
Pam Freeman
Danielle Smith
Amanda Brown
Heather Frey
Vyga Kaufmann
Neta Bargai
Julie Bemski
Jenell Ribble
Martine Lopez
Alana Henken
Kathryn Jargo
Liz Hooks
Tara Buckley
• Jordan Pock
• Andrea Reece
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Sara Rosenau
Natalie Tolejko
Kristen Simpson
Shari Watters
Kristen Mackiewicz
Michelle Brunner
Lindsay Heath
Kristin Nelson
Kate Slivka
Lindsay Smart
Susan Whittle
Elizabeth Goetter
Julie Lyons
Courtney Fiedler
Edyta Biegunajtys
Claire Heppner
Clara Paynter
Kelsey McNeill
Julie Lyons
• Shawna Henry-Lange
• Jenell Ribble
• Dena Miller
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Martine Lopez
Andrea Temple
Allison Glover
Sarah Morehouse
Jennifer DeVault
Debra Boeldt
Christine Kelley
Denise Onofrey
Edyta Biegunajtys
Jennell Ribble
Alanna Gangemi
Jenny Doft
Jenea Jones
Kristin Allen
Maddie Philley
Rachel Shulman
Denise Onofrey
NIH Funded Research
Risk Behaviors in Maltreated Adolescents
National Institute of Mental Health Dissertation Award, 1 R03 MH56781-01, $25,000.
Preventive Interventions for Foster Care Youth
National Institute of Mental Health, 1 K01 MH01972, $590,166.
Intervention Development and Pilot for Foster Care Youth
National Institute of Mental Health, 1 R21 MH067618, $472,500.
Fostering Healthy Futures Efficacy Trial for Preadolescent Youth in Foster Care
National Institute of Mental Health, 1 R01 MH076919, $2,655,734.
Research Supplement to Promote Diversity in Health Related Research
National Institute of Mental Health, 3 R01 MH0876919-02S1, $283,706.
Recovery Act Administrative Supplement Providing Summer Research
Experience for Student and Science Educators
National Institute of Mental Health, 3 R01 MH0876919-03S1, $18,670.
State, University, and Hospital Funding
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The Children’s Hospital Research Institute
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Tony Grampsas Youth Services, State of Colorado
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Colorado Clinical and Translational Sciences Institute
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Colorado Clinical and Translational Sciences Institute
Bridge Funding
Program Support for Fostering Healthy Futures
Academic Partnership for a collaboration between the
University of Colorado Denver and the Denver
Department of Human Services
Novel Methods Development Grant, Phase I accepted
proposal
Funding Through Kempe Foundation
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Daniels Fund ($20,000)
The Janus Foundation ($5,000)
Bonfils Stanton Foundation ($10,000)
PacifiCare ($10,000)
U.S. Bank ($5,000)
Daniels Fund ($50,000)
Pioneer Fund ($1,500,000 endowment for Fostering Healthy Futures)
Bonfils Stanton Foundation ($20,000)
Daniels Fund ($50,000)
Gannett Foundation ($3,000)
First Data/Western Union ($5,000)
Donor Advised Fund, Denver Foundation ($30,000)
Anschutz Family Foundation ($3,333)
Colorado Rockies Charity Fund ($10,000)
Denver Foundation ($15,000)
Daniels Fund ($60,000)
Anschutz Family Foundation ($4,167)
TJX Foundation ($3,000)
Rockies/McCormick Foundation ($20,000)
El Pomar Youth in Community Service - Arvada West High School ($500)
El Pomar Youth in Community Service - Northglenn High School ($1,500)
McGowan Foundation ($15,000)
Daniels Fund ($60,000)
MaggieGeorge Foundation ($16,000)
Xcel Energy Foundation ($5,000)
Rockies/McCormick Foundation ($20,000)
Larrk Foundation ($30,000)
Verdoorn Foundation ($15,000)
Anonymous ($5,000)
Daniels Fund ($60,000)
Rockies/McCormick Foundation ($10,000)
Verdoorn Foundation ($11,000)
El Pomar Award of Excellence
Fostering Healthy Futures Overview
Inclusion Criteria for RCT
All 9-11-year-old children in any type of out-of-home placement in participating
counties, including those placed in foster homes, kinship care, group homes,
and residential treatment centers, were recruited for study participation if they
also met the following criteria:
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Placed in court-ordered out-of-home care (over prior 12 months) as
result of maltreatment, and were in out-of-home care at the onset of
the intervention.
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Cognitive functioning at a level able to comprehend group material
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Spoke enough English to benefit from participation in the FHF skills
group curriculum
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Lived within 30 minutes of sites where groups are held
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Not a sibling of a child selected to participate
Youth continued to participate in the program even if they changed placements
or reunified.
Screening Evaluations
We assess functioning in the following domains:
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Cognitive (K-BIT)
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Academic achievement (WIAT Screener)
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Mental health (CDI, RCMAS, TSCC)
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Social (SSRS)
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Behavioral (CBCL)
Therapeutic Skills Groups
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30 weeks
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8 children per group, equal females and males
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Modifications of PATHS and Second Step curricula
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Mental health clinicians and graduate trainees facilitate
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1 hour group and then dinner with mentors
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Improve skills, process feelings related to the foster care
experience, and reduce stigma
Session Content
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First Quarter:
Feelings, perspective taking, problem solving, communication
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Second Quarter:
Self-talk, anger, worry, healthy coping, change and loss, Panel
Night, healthy relationships, peer pressure
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Third Quarter:
Drugs/alcohol, anatomy and puberty, dating pressures, abuse
prevention, healthy relationships, future orientation
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Graduation
Panel Night
Therapeutic Mentoring/Advocacy
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Graduate students spend 3-4 hours per week of individual
time with each child they mentor
They work on child’s lifebook, engage in extracurricular
activities, help find other adult role models, shadow adults
in professions of interest, work on homework, take them
to libraries, recreational activities, etc.
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Mentors advocate for appropriate services in all domains
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Mentors interface with other adults in child’s life
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Create a web of support for children, improve social skills,
and provide unconditional support and staunch advocacy
Graduate Student Supervision
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Intensive orientation
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1 hour of individual supervision weekly
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1 hour of group supervision weekly
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1 hour seminar on relevant topics weekly
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Supervisor available by cell phone after hours
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Multiple training opportunities within and outside Kempe
Cultural Presentations
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Encourage self-exploration
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Encourage self-respect and respect for others
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Supports problem-solving and perspective-taking
skills
Celebrate the difference and uniqueness each
child brings to group
Cultural Areas Explored
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Race/Ethnicity
Country of origin
Language
Family role/Family composition
Traditions
Being in out-of-home care
Gender
Religion
Neighborhood
School and peers
Career Shadows
and
Field Day
Qualitative Outcomes
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We conducted qualitative interviews with 100% of children and
families who participated in our intervention program in the
first year
Both caregivers and children were incredibly positive about the
program when we interviewed them a year later
Common themes included: feeling accepted, learning and
retaining skills, the importance of both group and mentoring,
the importance of the relationships established, sadness of
program ending (despite most liking the length of the
program), and too much pizza!
Stakeholder Feedback
Qualitative Quotes
Youth quotes about the program
“It was good ‘cause I got to be with people that were also in foster care and
you don’t get that a lot…so, it’s easier to cope with people when they have
the same feelings as you.”
“Not being alone…sometimes I don’t have a lot of people to talk to.”
“Talked about what we could do instead of making negative choices, like
growing up to get a college degree… We would talk about what our goals
were in life.”
“We had a real close relationship… She was somebody I could share my
feelings with because not most people I can share my feelings with…”
“It taught me that I wasn’t alone.”
“Helped me get along with life.”
Qualitative Quotes
Caregiver Quotes about the Program
“You could not ask for a better program to participate in…for [child], having
that bond experience and having someone he really got to develop a
relationship with and also have peers that were in the same position, that
was a huge positive.”
“They had a trust going and she reached him on a level that no one yet has
really been able to reach him.”
“I think it’s one of the things that got him through it. He had somewhere to go
to be able to talk about it and #1, didn’t have to be embarrassed or
ashamed, and #2, felt understood and accepted by his peers.”
“When dealing with this kind of thing, you’re always like ‘people are gonna look
at you as the bad parent because he was removed from my home because of
my anger, because of my mistake’…they made you feel more comfortable
with it…it’s a great, great program.”
Qualitative Quotes
Caseworker Quotes about the Program
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“I think it was also helpful to have other kids around that were in the same
situation, it made the kids feel that like they weren’t the only one in foster
care or out-of-home care. It certainly did help their self-esteem as far as the
group, they got to know other kids, they got to understand that they could
verbalize their feelings … I think that was very helpful.”
“I think it’s been very helpful for our kids to have 1:1 and when they have
somebody that focuses on them and their strengths and what they want to
do and what they want to be. It really builds confidence with our kids.”
For the children I think it was excellent. It opened them up to new, just a
whole new realm of things they probably would have never seen or even
thought of. I think for the children it increased their self-esteem, it made
them feel very important. When they were going to their groups, they were
very proud to say, ‘This is my mentor’. I think that was very, very helpful for
the children.”
Initial Cross-Sectional
Studies Examining
Baseline Data
Taussig, H.N., Culhane, S.E., & Hettleman, D. (2007).
Fostering Healthy Futures: An innovative preventive intervention for
preadolescent youth in out-of-home care.
Child Welfare, 86, 113-131.
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Published the program description
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Published the theoretical model
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Addressed some design concerns
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Addressed cultural concerns
FOSTERING HEALTHY FUTURES PREVENTIVE INTERVENTION
MODERATING FACTORS
•Demographic & Family Factors
•Type of Maltreatment
•Baseline Cognitive Functioning
•Baseline Behavioral Functioning
•Service Utilization
MEDIATING FACTORS
Cognitions
Social Functioning
Behavioral Functioning
•Self-Esteem and Efficacy
•Attitudes and Appraisals
•Future Orientation
•Social Support
•Competence & Acceptance
•Peer Associations
•Behavioral Regulation
•Coping Strategies
•Extracurricular Activities
DISTAL AND LIFE-COURSE OUTCOMES
Fewer Adverse Life-Course Outcomes
Better Distal Outcomes
•Mental Health
•Problem Behaviors
•Competencies
•Quality of Life
•Arrests and Incarceration
•Pregnancy and STDs
•School Failure and Dropout
•Emergency Mental Health Treatment
•Multiple and Restrictive Placements
•Associated Costs
Taussig, H.N., Garrido, E., & Crawford, G. (2009).
Use of a web-based data system in a clinical trial to obtain real-time
information on children placed in out-of-home care.
Social Work Research, 33, 55-60.
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NIH conference experience
Development and implementation of a web-based
caseworker survey tool
Collect real-time data from caseworkers
Secure, user-friendly and efficient (i.e. caseworkers can
import data from their administrative database)
Partnered with a child welfare information systems’
specialist
Raviv, T., Taussig, H.N., Culhane, S. E., & Garrido, E. F. (2010).
Cumulative risk exposure and mental health functioning among
maltreated youths placed in out-of-home care.
Child Abuse and Neglect, 34, 742-751.
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This study sought to elucidate the relation between cumulative risk and mental health
symptomatology
Results confirmed the high-risk nature of this sample and identified seven salient risk
variables:
 Physical abuse
 Sexual abuse
 Single parent household
 Number of caregiver transitions
 Number of school transitions
 Exposure to community violence
 Intellectual functioning
These seven variables were summed to create the cumulative risk index.
The cumulative risk index was a strong predictor of mental health symptoms,
differentiating between children who scored in the clinical range on mental health
symptoms and those who did not.
Rates (%) of Participants Scoring in the Clinical Range on
RCMAS Anxiety by Cumulative Risk Score
% in Clinical Range
25
20
15
10
RCMAS Anxiety
5
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0
1
2
3
4/5
Empirical Cumulative Risk Score
The data supported a linear model in which each incremental increase in
cumulative risk was accompanied by an increase in mental health problems.
Results & Implications
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Even in this high-risk sample (in which 48% of children in the overall
sample were in the clinical range with regard to externalizing behaviors),
the cumulative risk index significantly predicted problems.
Findings demonstrate that although all children placed in out-of-home care
have experienced serious life adversities, they are not identical with regard
to their exposure to risk factors—nor are they homogeneous with regard to
their likelihood of experiencing mental health symptoms.
Of the variables comprising the cumulative risk index, several represent
characteristics of the child or the child’s experience that are external to his
or her immediate family (number of school transitions, exposure to
community violence, intellectual functioning)
We intend to use this index in future studies to investigate whether initial
levels of cumulative risk may moderate the effects of the prevention
program.
Such findings would enable us to allocate resources more effectively.
Garrido, E. F., Taussig, H.N., Culhane, S. E., & Raviv, T. (2010).
Does community violence exposure predict trauma symptoms in a sample of
maltreated youth in foster care?
Violence and Victims, 25, 756-770.
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Family violence exposure and community violence exposure in
childhood often co-occur and both are associated with increased
levels of trauma symptoms.
Despite their high rate of co-occurrence and similar associated
outcomes, few studies have examined whether community violence
exposure predicts trauma symptoms over and above the impact of
family violence exposure.
Although independent studies have found that negative coping
strategies (e.g., avoidance, aggression) mediate the association
between violence exposure and trauma symptoms, no known
studies have examined whether these coping strategies function in a
similar manner across violence exposure types.
Rates of Violence Exposure
Community Violence
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95.5% of participants reported exposure in the previous year
M = 9.67 (SD = 8.07) number of witnessed acts of community violence
Family Violence (domestic violence and physical abuse)
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35.8% of participants had no exposure
47.5% of participants had been exposed to one type of family violence
16.8% of participants had been exposed to both types of family violence
Sex Differences
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Boys and girls did not differ from one another on rates/frequency
Negative Coping as a Mediator of the Association between
Community Violence Exposure and Trauma Symptoms
Negative Coping
Skills
β=.24, p < .001
Community
Violence
Exposure
β=.41, p < .001
Indirect Effect, β=.21, p<.01
Trauma
Symptoms
Direct Effect, β=.30, p<.001
Sobel’s Test – z = 3.17, p < .01, 30% of the effect attenuated
Garrido, E. F., Culhane, S. E., Petrenko, C. L. M., & Taussig, H. N. (in press).
Psychosocial consequences of caregiver transitions for maltreated youth
entering foster care: The moderating impact of community violence exposure.
American Journal of Orthopsychiatry
• Youth exposed to a greater number of caregiver
transitions have been found to be at risk of experiencing a
variety of negative psychosocial outcomes
• While previous studies have explored individual-level
variables that moderate this association, no known
studies have explored the impact of community-level
factors
• In the current study we used youth reports of community
violence exposure (CVE) to examine whether CVE
moderated the impact of early caregiver transitions on
later caregiver-, teacher-, and youth-reported
internalizing and externalizing problems
Increases in Psychosocial Problems as a Function of
Caregiver Transitions and Community Violence Exposure
(CVE)
TRF EXTERNALIZING RAW SCORES
50
45
40
35
Low CVE
High CVE
30
25
20
15
Low Caregiver Transitions
High Caregiver Transitions
Garrido, E. F., Taussig, H.N., Culhane, S. E., & Raviv, T. (in press).
Attention problems mediate the association between physical abuse severity
and aggressive behavior in a sample of maltreated early adolescents.
Journal of Early Adolescence
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Multiple studies have documented the association
between childhood physical abuse and aggressive
behavior.
Fewer studies have explored possible mediating
mechanisms that may explain this association.
The purpose of the current study was to examine
whether attention problems mediate the association
between physical abuse and aggressive behavior.
Attention Problems as a Mediator of the Association
between Severity of Physical Abuse and Aggression
β=.17, p < .01
Severity of
Physical Abuse
Attention
Problems
β=.67, p < .001
Indirect Effect, β=.08, p = .12
Aggression
Direct Effect, β=.19, p < .01
Sobel’s Test – z = 2.79, p < .01, 58% of the effect attenuated
Taussig, H.N., & Culhane, S.E. (2010)
Emotional maltreatment and psychosocial functioning in a sample of
preadolescent youth placed in out-of-home care.
Journal of Aggression, Maltreatment and Trauma, 19, 52-74
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Study examined the impact of emotional maltreatment on psychosocial
outcomes
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Highlighted importance of looking at subtypes of emotional abuse, as they
were associated with different outcomes
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Verbal aggression was associated with lower perceived social acceptance
and self-esteem, but overall emotional abuse was not

Abandonment was related to greater anxiety and lower life satisfaction, but
overall emotional maltreatment was not

Inappropriate responsibility was related to fewer social problems

Males who experienced emotional abuse were faring more poorly than
males who did not experience emotional abuse in the following domains:
posttraumatic stress, anxiety, self-esteem, life satisfaction, and attachment
to peers and parents
Miller Dunn, D., Taussig, H.N., & Culhane, S.E. (2010)
Children’s appraisals of their experiences in out-of-home care.
Children and Youth Services Review, 32, 1324-1330.

“If you had not been removed from your home, would
your life be:”




42% Better than it is now
26% Same as it is now
27% Worse than it is now
“Has being placed in out-of-home care been:”



33% Very difficult
34% Okay
34% Very good/Helpful
Baseline Appraisals

Youth who said life would have been worse had they
remained with their biological parents were more likely
to be:





Female
Sexually abused
Emotionally maltreated
Satisfied with current out-of-home placement and caregiver
Appraisals did not differ based on:






Age
Race/Ethnicity
Length of time in out-of-home care
Neglect
Severity of maltreatment
Type of placement
Baseline Qualitative Responses
What’s been the most helpful thing about being in foster care?

“People are starting to listen to me and I’m getting more done”

“I’m getting better cleaning”

“Giving mom an easier way to catch up”

“Don’t have to live on the street until they [bio parents] get out of jail”

“Not being beat”

“I don’t have to take care of my brother. I just have to take care of me.”

“That I am free to go to school”

“Living!”

“Being loved”
Baseline Qualitative Responses
What’s been the hardest thing about being in foster care?

“Seems like I will never see my mom again”

“Eating food I don’t like”

“Not having friends”

“Being alone”

“Having people make promises to me and not following through”

“Having to be moving from treatment center to treatment center”

“Foster parents are not my type”

“Can’t think of any”
Taussig, H., Culhane, S., Raviv, T., Fitzpatrick, L., & Wertheimer, R. (2010).
Mentoring children in foster care: Impact on gradate student mentors.
Educational Horizons, 89, 17-32.

50 of 52 mentors who had participated in the program
over one of the past 6 years completed online survey

Almost all the mentors reported that their participation
was helpful or very helpful in training them to work with:

High-risk children and families

Diverse communities

Multiple systems

Other professionals
Qualitative Response Themes

Participation as a mentor was a challenging, but
rewarding experience

Led to the acquisition of new skills and greater
confidence

The intense training and supervision provided was
essential

Mentoring was a catalyst for mentors’ self-exploration
and personal growth

Demonstrated the impact that mentoring can have on
children’s lives
First Outcome Study Examining
Mental Health Outcomes
Taussig, H.N., & Culhane, S.E. (in press)
Impact of a mentoring and skills group program on mental health
outcomes for maltreated children in foster care.
Archives of Pediatrics and Adolescent Medicine.




Interviews with parents/caregivers and youth are
conducted immediately post-intervention (T2) and then 6
months later (T3).
Teacher surveys are collected in the spring of two
consecutive years.
School records are abstracted at the same timepoints.
Child welfare histories are coded from the legal petitions
and social histories completed by caseworkers when filing
to have children removed from their homes.
Recruitment and Retention Rates
(for the first 5 cohorts)



92% of eligible youth were recruited for this voluntary program
93% of those randomized to the intervention began the
intervention
92% of those who began the intervention completed it; youth
who dropped out were included in intent-to-treat analyses

92% completed the Time 2 interview

93% completed the Time 3 interview

Over 90% of caregivers and teachers were interviewed at each
timepoint
Program Uptake




Children attended an average of 25 (median=27)
of the 30 skills group sessions
Mentors met with youth an average of 27
(median=28) of 30 times
These numbers include children (n=5) who
withdrew from the program
An average of 96% of the 108 discrete skills
group activities were completed
Quantitative Analytic Strategy

Conducted bivariate analyses to determine which variables differed
between treatment conditions

Conducted correlational analyses to determine whether these variables
impacted outcomes

Included control variables based on both their unequal distribution
among groups and their impact on outcome variables

Used the same control variables in each analysis

Conducted separate regression analyses for Time 2 and Time 3

For dichotomous outcome variables, conducted logistic regression

All analyses were intent-to-treat
Baseline Characteristics
Control
(n=77)
Intervention
(n=79)
Gender (male)
49.4%
51.9%
Age (mean)
10.4
10.4
Race/Ethnicity (non-exclusive)
Caucasian
Hispanic
African American
Native American
44.2%
55.8%
24.7%
7.8%
42.3%
44.3%
34.6%
10.3%
Baseline Characteristics (cont.)
Control
Maltreatment
Physical Abuse
Sexual Abuse
Failure to Provide
Lack of Supervision
Emotional Abuse
Moral/Legal
Exp. to Domestic Violence
Intervention
24.7%
14.3%
51.9%
74.0%
66.2%
27.3%
28.0%
39.2%
8.9%
46.8%
77.2%
57.0%
40.5%
23.7%
Mean Number of Times Family
Referred to Social Services
3.2
4.2
Mean Length of Time in
out-of-home care (years)
.60
.60
Baseline Characteristics (cont.)
Control
Intervention
Drug use/dependence
58.4%
70.9%
Criminal history
44.2%
64.6%
Chronic medical problems
19.5%
17.9%
Mental illness
37.7%
39.2%
Housing issues
32.5%
38.0%
Childhood maltreatment
19.5%
24.1%
7.8%
11.4%
Maternal Characteristics
Foster care
Placement Type
Foster Care
61%
42%
Kinship Care
32%
51%
7%
7%
Group Home/RTC/Shelter
Baseline Characteristics (cont.)
Cognitive Functioning, mean
K-BIT Vocabulary
K-BIT Matrices
K-BIT Composite
Control
Intervention
89.2
100.0
94.0
93.6
103.3
98.2
Mental Health Functioning (% above clinical cutpoint)
CBCL – Internalizing
45.5%
CBCL – Externalizing
48.1%
CBCL – Total Problems
54.5%
CBCL – Total Competence
35.5%
RCMAS – Anxiety
7.8%
CDI – Depression
11.7%
TSCC - PTSD
5.3%
45.6%
49.4%
48.1%
33.8%
11.4%
6.3%
3.4%
T2 Mental Health Outcomes
(Controlling for T1 var, IQ, Mom’s Criminal Hx, Physical & Moral/Legal Abuse)
Cohen’s d/
Primary Outcomes
MH Factor (y, cg, t)
Trauma Symptoms (y)
Dissociation (y)
Depression (y)
Anxiety (y)
Recent MH Tx (y)
Current MH Tx (cg)
Recent MH Meds (y)
Current MH Meds (cg)
Quality of Life (y)
Secondary Outcomes
Positive Coping (y)
Negative Coping (y)
Global Self Worth (y)
Social Acceptance (y)
Social Support Factor (y)
OR (95% CI)
p
.07
-.10
-.13
-.06
-.25
.88 (.70, 1.11)
.81 (.62, 1.06)
.65 (.33, 1.29)
1.07 (.59, 1.94)
.42
.66
.53
.44
.65
.08
.28
.12
.57
.83
<.01
.09
-.08
.05
.16
.25
.59
.64
.76
.32
.10
T3 Mental Health Outcomes
(Controlling for T1 var, IQ, Mom’s Criminal Hx, Physical & Moral/Legal Abuse)
Cohen’s d/
Primary Outcomes
MH Factor (y, cg, t)
Trauma Symptoms (y)
Dissociation (y)
Depression (y)
Anxiety (y)
Recent MH Tx (y)
Current MH Tx (cg)
Recent MH Meds (y)
Current MH Meds (cg)
Quality of Life (y)
Secondary Outcomes
Positive Coping (y)
Negative Coping (y)
Global Self Worth (y)
Social Acceptance (y)
Social Support Factor (y)
OR (95% CI)
p
-.51
-.30
-.39
-.19
-.25
.75 (.57, .98)
.82 (.59, 1.1)
.67 (.34, 1.3)
.61 (.30, 1.3)
.14
<.01
.07
.02
.18
.23
.04
.21
.25
.18
.38
.25
-.21
.19
.17
.02
.15
.16
.23
.30
.89
Summary




First known rigorous RCT of a skills group and mentoring
preventive intervention for preadolescent youth in out-ofhome care
Strong recruitment, retention and program uptake
Pattern of finding suggests that the FHF preventive
intervention reduces mental health symptomatology and
treatment, 6-months post-program.
Finding did not support mediation hypotheses, with the
exception of a trend showing greater social support at T2.

Impact on mentoring field; lack of selection bias

Overall, we are encouraged by these preliminary findings.
Next Steps


Analyze school and placement outcomes
Conduct subgroup analyses – gender, IQ, placement type,
race/ethnicity

Conduct mediation analyses

Begin to analyze T4 data, 3.5 years post-enrollment

Initiate T5 follow-up, when youth are 18-21

Initiate the collection of biological data
Cohort 7 Math Grades
Pre- and Post-Test Math Scores by Intervention Status
0.66
0.64
Adjusted Score
0.62
0.6
Pre-test
Post-test
0.58
0.56
0.54
0.52
Intervention
Control
Group
Lessons Learned


Chunk grants
Evaluate all aspects of program both qualitatively and
quantitatively

Do formative work before large-scale trial

Cohorts are challenging

Soft $ is both a challenge and an opportunity

Maintain community relationships
Ruth Kempe
“How can we show that child abuse
prevention provides the same kinds of
benefits to society that, for example,
immunization from infectious disease does?
How can we show that the work in our field
helps society achieve better things? We don’t
have enough long-term studies. We don’t
have good proof that what we do works. So,
that’s an area we need to concentrate on, I
think; and that’s probably true everywhere.”
“There are a couple of long-term things that I
think are especially worthwhile. I think there
is a need for long-term research, in order to
better demonstrate our work. If we make
mistakes, we need to learn from them. Longterm research may be expensive, but if we
keep good records, with the data we have
right now, we should learn what is working
and what is not—at least we will get a better
sense of direction.”
-ISPCAN Interview, 2008